POS0607 IMPROVING TREAT-TO-TARGET IMPLEMENTATION IN RHEUMATOID ARTHRITIS: A SYSTEMATIC LITERATURE REVIEW OF BARRIERS, FACILITATORS, AND INTERVENTIONS
Authors: L. Gossec, L. Bessette, R. Xavier, E. G. Favalli, A. Ostor, M. H. Buch
Journal: Annals of the Rheumatic Diseases (2022)

Background Treat-to-target (T2T) is integral to international recommendations for managing patients with rheumatoid arthritis (RA), 1,2 but its implementation in clinical practice is suboptimal. 3 Understanding T2T barriers and facilitators may inform strategies for improving T2T implementation in RA. Objectives To review published evidence on barriers to and facilitators of T2T implementation in RA, and interventions designed to improve T2T implementation. Methods Two systematic literature searches were conducted to identify barriers to or facilitators of, and interventions designed to improve, T2T implementation in RA (Jan 1, 2015–Mar 1, 2021 and Jan 1, 2010–Jul 1, 2021, respectively). The quality of each study was assessed using the appropriate Critical Appraisal Skills Programme (CASP) checklist. 4 Barriers/facilitators and interventions were grouped into categories and summarized descriptively. Results The barriers/facilitators literature search retrieved 235 articles. Seventy-seven of these, which described primary studies mentioning a total of 331 T2T barriers/facilitators in RA, were included in the analysis. The interventions literature search identified 451 articles, including 70 primary studies reporting a total of 56 unique interventions to improve T2T implementation in RA. The quality of the studies varied; however, most addressed at least half of the information evaluated in the CASP checklists. Barriers/facilitators were categorized into 18 key target areas for patients (n=7), healthcare professionals (HCPs; n=6), or patients and HCPs (n=5). These related to: HCPs’ or patients’ knowledge or perceptions; patients’ clinical or social conditions; patient–HCP communication or alignment; and time or resources (Figure 1). The 56 interventions were grouped into 18 types (Table 1). More than half of the interventions (n=30; 53.6%) were designed to improve or streamline disease activity or patient-reported outcome assessments or increase patient–HCP alignment on disease activity. Interventions designed to improve shared decision-making were also common (n=23; 41.1%); these included patient and HCP education (n=15), decision aids (n=7), and shared decision-making prompts (n=3). Of the 56 interventions, 20 (35.7%) reported improvements in T2T implementation and/or patient outcomes in RA. However, as most interventions were evaluated in single centers, their effectiveness, feasibility, and generalizability across other regions or healthcare settings were unclear. Table 1. Interventions for improving T2T implementation in RA, by type Type of intervention Number of unique interventions (n=56) a Electronic disease assessment recording 11 Disease assessment process/quality improvement initiative 8 Allied HCP-supported T2T strategy 8 Patient educational tools 7 Patient decision aid 7 HCP performance feedback 7 Integrated PRO assessment 6 Ultrasound assessment 5 HCP learning collaborative (structured learning sessions + performance feedback) 4 Patient PRO dashboard/visual feedback tool 4 Telehealth monitoring 3 HCP T2T/shared decision-making prompt 3 Nurse-led patient education 3 Multidisciplinary team program 3 HCP training 2 Patient telehealth education 2 HCP decision-making tool 1 Patient group sessions 1 a Interventions may be assigned to more than one category PRO, patient-reported outcome Conclusion While practical methods designed to improve T2T implementation in RA are available, their effectiveness and feasibility will likely vary by region and healthcare setting. More primary research is required to identify the most relevant barriers/facilitators and prioritize the most appropriate interventions to optimize T2T implementation both globally and locally. References [1]Smolen JS, et al. Ann Rheum Dis 2020;79:685–99 [2]Smolen JS, et al. Ann Rheum Dis 2016;75:3–15 [3]Yu Z, et al. Arthritis Care Res 2018;70:801–6 [4]Critical Appraisal Skills Programme 2019. https://casp-uk.net/casp-tools-checklists/ (Last accessed November 2021) Acknowledgements AbbVie funded the evidence synthesis and had the opportunity to review and comment on the publication prior to submission. However, decisions regarding the final publication content were made solely by the authors. Medical writing support was provided by Hilary Wong, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie. Disclosure of Interests Laure Gossec Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, and UCB, Grant/research support from: Amgen, Galapagos, Lilly, Pfizer, and Sandoz, Louis Bessette Consultant of: AbbVie, Celgene, Fresenius Kabi, Gilead, Lilly, Novartis, Pfizer, Sandoz, and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB, Ricardo Xavier Speakers bureau: AbbVie, Janssen, Lilly, Novartis, Pfizer, and Roche, Consultant of: AbbVie, Janssen, Lilly, Novartis, Pfizer, and Roche, Grant/research support from: AbbVie, Janssen, Lilly, and Pfizer, Ennio Giulio Favalli Speakers bureau: AbbVie, Bristol-Myers Squibb, Celltrion, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Sanofi-Genzyme, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celltrion, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Sanofi-Genzyme, and UCB, Andrew Ostor Consultant of: AbbVie, Bristol-Myers Squibb, Gilead, Janssen, Lilly, Novartis, Paradigm, Pfizer, Roche, and UCB, Grant/research support from: AbbVie, Bristol-Myers Squibb, Gilead, Janssen, Lilly, Novartis, Paradigm, Pfizer, Roche, and UCB, Maya H Buch Consultant of: AbbVie, Boehringer Ingelheim, Galapagos, Gilead, Lilly, and Pfizer (consulting fees paid to the host institution and travel honoraria), Grant/research support from: Pfizer and UCB